Neuman Systems Model-Based Yoga Therapy for Test Anxiety in Secondary School Students

This cluster randomized controlled trial was designed to evaluate the effects of a yogatherapy program grounded in Neuman Systems Model on test anxiety, quality of life, andmindfulness levels among 13‐14‐year‐old middle school students. The target populationconsisted of eighth‐grade students attending schools in the central districts of Denizliprovince, Türkiye. In Türkiye, eighth‐grade students prepare for the nationwide HighSchool Entrance System (LGS) examination and may experience high academic pressure andtest anxiety. Therefore, the study was conducted with eighth‐grade students.The inclusion criteria were defined as being an eighth‐grade student, having no physicalor mental disability, agreeing to participate voluntarily in the study, and providingparental consent. Students with prior regular yoga experience were excluded to minimizepotential confounding factors that could influence the effects of the intervention.Among 68 public middle schools in the central districts of Denizli, 27 schools thatagreed to participate constituted the study pool. From this pool, two schools meeting theeligibility criteria were selected using simple random sampling. Each school wasconsidered a cluster. The selected schools were then allocated to intervention andcontrol groups by an independent researcher using a simple randomization method.Following randomization, two classes were randomly selected from seven eighth‐gradeclasses in the intervention school, and two classes were randomly selected from nineeighth‐grade classes in the control school. Cluster randomization at the school level wasemployed to minimize contamination due to potential information exchange betweenintervention and control groups.The sample size was calculated using G*Power version 3.1.9.4. The calculation was basedon a study design involving two groups and three measurement time points. Arepeated‐measures analysis of variance (ANOVA) was used with a medium effect size (f =0.25), a significance level of 0.05, and a statistical power of 0.95. The minimumrequired sample size was determined to be 142 students. Considering potential attrition,it was planned to include 80 students in each group, for a total of 160 students.Ultimately, the study sample consisted of 166 students, with 81 in the intervention groupand 85 in the control group.The yoga therapy program was developed in collaboration with the researcher, who iscertified in children's yoga, and two certified yoga experts with experience in adultyoga, children's yoga, and mindfulness‐based practices. The intervention was deliveredjointly by the researcher and one of the certified yoga instructors. The program wasconducted over four weeks, with one 40‐minute session per week. Each session consisted ofbreathing awareness and intention setting (5 minutes), warm‐up exercises (5 minutes),yoga postures aimed at improving attention, balance, strength, and self‐confidence (15minutes), pranayama practices designed to reduce anxiety and enhance focus (5 minutes),and relaxation with mindfulness‐based meditation (10 minutes).Outcome variables were assessed using the Westside Test Anxiety Scale for test anxiety,the Quality of Life Scale for Children and Adolescents (13‐18 years version) for qualityof life, the BAU Mindfulness Scale for Children for mindfulness levels, and aresearcher‐developed Student Information Form for demographic characteristics. Data werecollected at three time points: baseline assessment before the first interventionsession, mid‐assessment after the second session, and post‐assessment after the fourthsession.The study was approved by the Non‐Interventional Clinical Research Ethics Committee ofPamukkale University and conducted with the necessary institutional permissions from theMinistry of National Education. Participation was voluntary, and written informed consentwas obtained from parents or legal guardians of all participating students.